Provider Demographics
NPI:1972013639
Name:ZITTERKOPF, JACOB GERHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:GERHARD
Last Name:ZITTERKOPF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2221 E BIJOU ST STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-8009
Mailing Address - Country:US
Mailing Address - Phone:719-576-1850
Mailing Address - Fax:719-955-3470
Practice Address - Street 1:1407 W 84TH AVE UNIT B8
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80260-4753
Practice Address - Country:US
Practice Address - Phone:720-214-4746
Practice Address - Fax:720-214-4745
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002032881223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1972013639Medicaid